Endovascular Treatment of Complex Distal Posterior Cerebral Artery Aneurysms with the Pipeline Embolization Device

Mazaris, Paul; Mehta, Tapan; Hussain, Mohammed; Inoa, Violiza; Singer, Justin; Spiegel, Gary; Kureshi, Inam; Ollenschleger, Martin

doi:10.1016/j.wneu.2017.04.037

Cited by 15 publications

(7 citation statements)

References 18 publications

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“…Posterior circulation aneurysms have been historically hard to clip or coil, especially those originating off the SCA and AICA. Several techniques have been tried, such as endovascular pipeline embolization devices, microsurgical skull base approaches, and the supraorbital keyhole approach for clip application 15,16,17 . While these techniques are successful in some cases, the widespread applicability is limited due to stark differences in patient anatomy and the difficult to access posterior location of the vessels.…”

Section: Discussionmentioning

confidence: 99%

Development of a Cadaveric Multiport Model of Posterior Circulation Aneurysm Clipping for Neurosurgery and Otolaryngology Residents

Gillham

Lucke‐Wold

Doğan

et al. 2021

JoVE

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Posterior circulation aneurysms are difficult to treat with the current methods of coiling and clipping. To address limitations in training, we developed a cadaveric model to train learners on endoscopic clipping of posterior circulation aneurysms. An endoscopic transclival approach (ETA) and a transorbital precaruncular approach (TOPA) to successfully access and clip aneurysms of the posterior circulation are described. The model has flexibility in that a colored silicone compound can be injected into the cadaveric vessels for the purpose of training learners on vascular anatomy. The other option is that the model could be connected to a vascular perfusion pump allowing real-time appreciation of a pulsatile or ruptured aneurysm. This cadaveric model is the first of its kind for training of endoscopic clipping of posterior circulation aneurysms. Learners will develop proficiency in endoscopic skills, appropriate dissection, and appreciation for relative anatomy while developing an algorithm that can be employed in a real operative arena. Going forward, various clinical scenarios can be developed to enhance the realism, allow learners from different specialties to work together, and emphasize the importance of teamwork and effective communication.

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Section: Discussionmentioning

confidence: 99%

Development of a Cadaveric Multiport Model of Posterior Circulation Aneurysm Clipping for Neurosurgery and Otolaryngology Residents

Gillham

Lucke‐Wold

Doğan

et al. 2021

JoVE

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“…However, the effects of these stents are uncertain. Currently, flow-diverting stents (FDSs) are revolutionizing EVT, and off-label FDS use has extended EVT from the proximal ICA aneurysm to distal intracranial artery aneurysms, including those in the PCA trunk, especially unruptured aneurysms with no collateral or poor collateral supply (101).…”

Section: Flow-diverting Stentmentioning

confidence: 99%

“…However, FDS deployment in the distal vessel remains a challenge, although FDS deployment can be successful in a PCA with a tortuous path (102)(103)(104). Due to the dense perforator arteries of the P1 segment and the limitation of PCA diameter, perforating artery ischemia and varying degrees of in-stent stenosis or occlusion can occur (Figure 9) (101).…”

Section: Flow-diverting Stentmentioning

confidence: 99%

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Endovascular Treatment of Posterior Cerebral Artery Trunk Aneurysm: The Status Quo and Dilemma

Hou

2022

Front. Neurol.

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The posterior cerebral artery (PCA) is an important artery that can be divided into four segments (P1-4): segments P1-2 are proximal segments, and segments P3-4 are distal segments. Various aneurysms can occur along the PCA trunk. True saccular aneurysms are rare, and most PCA trunk aneurysms are dissecting. Sometimes, the PCA trunk can give rise to flow-related aneurysms in association with high-flow arteriovenous shunt diseases or moyamoya disease and internal carotid artery occlusion. Some PCA trunk aneurysms require treatment, especially ruptured or large/giant aneurysms. Recently, endovascular treatment (EVT) has become the mainstream treatment for PCA trunk aneurysms, and it mainly involves reconstructive or deconstructive techniques. Traditional EVT includes selective coiling with/without stent or balloon assistance and parent artery occlusion (PAO). For proximal aneurysms, the PCA should be preserved. For distal aneurysms, PAO can be performed. However, during EVT, preservation of the PCA must naturally be the prime objective. Recently, flow-diverting stents have been used and are a revolutionary treatment for unruptured dissecting aneurysms of the PCA trunk. Despite the associated complications, EVT remains an effective method for treating PCA trunk aneurysms and can result in a good prognosis.

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“…With treatment device technologies constantly evolving to achieve a higher level of safety and better outcomes, endovascular interventions are increasingly the preferred treatment for cerebrovascular conditions such as aneurysms and strokes. Flow diversion devices such as the Pipeline embolization device (PED; Medtronic, Dublin, Ireland), originally designed for the treatment of internal carotid artery aneurysms,1 are now used for the treatment of a wide range of aneurysms including aneurysms located on more distal intracranial vessels and aneurysms with complex anatomy 2 3. In such cases, high quality imaging becomes increasingly important.…”

Section: Introductionmentioning

confidence: 99%

Single-center experience of using high definition (Hi-Def) imaging during neurointervention treatment of intracranial aneurysms using flow diverters

Nagesh

Vakharia

Waqas

et al. 2020

J NeuroIntervent Surg

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BackgroundA new dual resolution imaging x-ray detector system (Canon Medical Systems Corporation, Tochigi, Japan) has a standard resolution 194 µm pixel conventional flat-panel detector (FPD) mode and a high-resolution 76 µm high-definition (Hi-Def) mode in a single unit. The Hi-Def mode enhances the visualization of the intravascular devices.ObjectiveWe report the clinical experience and physician evaluation of this new detector system with Hi-Def mode for the treatment of intracranial aneurysms using a Pipeline embolization device (PED).MethodsDuring intervention at our institute, under large field of view (FOV) regular resolution FPD mode imaging, the catheter systems and devices were first guided to the proximity of the treatment area. Final placement and deployment of the PED was performed under Hi-Def mode guidance. A post-procedure 9-question physician survey was conducted to qualitatively assess the impact of Hi-Def mode visualization on physicians’ intraoperative decision-making. One-sample t-test was performed on the responses from the survey. Dose values reported by the x-ray unit were also recorded.ResultsTwenty-five cases were included in our study. The survey results indicated that, for each of the nine questions, the physicians in all cases indicated that the Hi-Def mode improved visualization compared with the FPD mode. For the 25 cases, the mean cumulative entrance air kerma was 2.35 Gy, the mean dose area product (DAP) was 173.71 Gy.cm2, and the mean x-ray exposure time was 39.30 min.ConclusionsThe Hi-Def mode improves visualization of flow diverters and may help in achieving more accurate placement and deployment of devices.

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Endovascular Treatment of Complex Distal Posterior Cerebral Artery Aneurysms with the Pipeline Embolization Device

Cited by 15 publications

References 18 publications

Development of a Cadaveric Multiport Model of Posterior Circulation Aneurysm Clipping for Neurosurgery and Otolaryngology Residents

Development of a Cadaveric Multiport Model of Posterior Circulation Aneurysm Clipping for Neurosurgery and Otolaryngology Residents

Endovascular Treatment of Posterior Cerebral Artery Trunk Aneurysm: The Status Quo and Dilemma

Single-center experience of using high definition (Hi-Def) imaging during neurointervention treatment of intracranial aneurysms using flow diverters

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